Television Viewing Time and Mortality: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

Background— Television viewing time, the predominant leisure-time sedentary behavior, is associated with biomarkers of cardiometabolic risk, but its relationship with mortality has not been studied. We examined the associations of prolonged television viewing time with all-cause, cardiovascular disease (CVD), cancer, and non-CVD/noncancer mortality in Australian adults. Methods and Results— Television viewing time in relation to subsequent all-cause, CVD, and cancer mortality (median follow-up, 6.6 years) was examined among 8800 adults ≥25 years of age in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). During 58 087 person-years of follow-up, there were 284 deaths (87 CVD deaths, 125 cancer deaths). After adjustment for age, sex, waist circumference, and exercise, the hazard ratios for each 1-hour increment in television viewing time per day were 1.11 (95% confidence interval [CI], 1.03 to 1.20) for all-cause mortality, 1.18 (95% CI, 1.03 to 1.35) for CVD mortality, and 1.09 (95% CI, 0.96 to 1.23) for cancer mortality. Compared with a television viewing time of <2 h/d, the fully adjusted hazard ratios for all-cause mortality were 1.13 (95% CI, 0.87 to 1.36) for ≥2 to <4 h/d and 1.46 (95% CI, 1.04 to 2.05) for ≥4 h/d. For CVD mortality, corresponding hazard ratios were 1.19 (95% CI, 0.72 to 1.99) and 1.80 (95% CI, 1.00 to 3.25). The associations with both cancer mortality and non-CVD/noncancer mortality were not significant. Conclusions— Television viewing time was associated with increased risk of all-cause and CVD mortality. In addition to the promotion of exercise, chronic disease prevention strategies could focus on reducing sitting time, particularly prolonged television viewing.

[1]  J. Shaw,et al.  Risk of Cardiovascular and All-Cause Mortality in Individuals With Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance: The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) , 2007, Circulation.

[2]  Marc T. Hamilton,et al.  Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes, and Cardiovascular Disease , 2007, Diabetes.

[3]  W. Willett.  Implications of Total Energy Intake for Epidemiologic Analyses , 1998 .

[4]  S B Hulley,et al.  Television viewing and cardiovascular risk factors in young adults: the CARDIA study. , 1996, Annals of epidemiology.

[5]  E. Rimm,et al.  Activity level and risk of overweight in male health professionals. , 1996, American journal of public health.

[6]  U. Ekelund,et al.  Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study. , 2011, International journal of epidemiology.

[7]  S G Trost,et al.  Test-retest reliability of four physical activity measures used in population surveys. , 2004, Journal of science and medicine in sport.

[8]  R. Jeffery,et al.  Epidemic obesity in the United States: are fast foods and television viewing contributing? , 1998, American journal of public health.

[9]  Frank B. Hu,et al.  Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality: Sixteen Years of Follow-Up in US Women , 2008, Circulation.

[10]  B. Popkin,et al.  The Diet Quality Index revised: a measurement instrument for populations. , 1999, Journal of the American Dietetic Association.

[11]  Jo Salmon,et al.  Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. , 2003, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[12]  J. Shaw,et al.  Physical activity and television viewing in relation to risk of undiagnosed abnormal glucose metabolism in adults. , 2004, Diabetes care.

[13]  W. Willett,et al.  Isotemporal substitution paradigm for physical activity epidemiology and weight change. , 2009, American journal of epidemiology.

[14]  J. Shaw,et al.  The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)--methods and response rates. , 2002, Diabetes research and clinical practice.

[15]  Walter C Willett,et al.  Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. , 2003, JAMA.

[16]  Jean-Michel Oppert,et al.  Sedentary behaviors, physical activity, and metabolic syndrome in middle-aged French subjects. , 2005, Obesity research.

[17]  H Löllgen,et al.  Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories. , 2009, International journal of sports medicine.

[18]  D. Jolley,et al.  Associations of TV viewing and physical activity with the metabolic syndrome in Australian adults , 2005, Diabetologia.

[19]  A. Tonkin,et al.  Accuracy of the Australian National Death Index: comparison with adjudicated fatal outcomes among Australian participants in the Long‐term Intervention with Pravastatin in Ischaemic Disease (LIPID) study , 2003, Australian and New Zealand journal of public health.

[20]  J. Shaw,et al.  Association of television viewing with fasting and 2-h postchallenge plasma glucose levels in adults without diagnosed diabetes. , 2007, Diabetes care.

[21]  M. Inoue,et al.  Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC study). , 2008, Annals of epidemiology.

[22]  M. Thun,et al.  Recreational physical activity and sedentary behavior in relation to ovarian cancer risk in a large cohort of US women. , 2006, American journal of epidemiology.

[23]  D. Warburton,et al.  Health benefits of physical activity: the evidence , 2006, Canadian Medical Association Journal.

[24]  E. Rimm,et al.  Reproducibility and validity of the Diet Quality Index Revised as assessed by use of a food-frequency questionnaire. , 2003, The American journal of clinical nutrition.

[25]  G A Colditz,et al.  Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. , 2001, Archives of internal medicine.

[26]  C. Bouchard,et al.  Sitting time and mortality from all causes, cardiovascular disease, and cancer. , 2009, Medicine and science in sports and exercise.

[27]  J. Shaw,et al.  Overweight and obesity in Australia: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) , 2003, The Medical journal of Australia.

[28]  J. Manson,et al.  Walking compared with vigorous exercise for the prevention of cardiovascular events in women. , 2002, The New England journal of medicine.

[29]  B. Leese.  Prevention of diabetes mellitus. Report of a WHO Study Group. , 1995, World Health Organization technical report series.

[30]  N. Day,et al.  Television viewing and low participation in vigorous recreation are independently associated with obesity and markers of cardiovascular disease risk: EPIC-Norfolk population-based study , 2003, European Journal of Clinical Nutrition.

[31]  J. Shaw,et al.  Objectively Measured Sedentary Time, Physical Activity, and Metabolic Risk , 2007, Diabetes Care.

[32]  Takemi Sugiyama,et al.  Validity and reliability of measures of television viewing time and other non‐occupational sedentary behaviour of adults: a review , 2009, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[33]  A. Schatzkin,et al.  Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study , 2008, Cancer Causes & Control.

[34]  D. Istance.  Organization for Economic Co-operation and Development , 1966, Nature.

[35]  M. Singer,et al.  Nutritional Epidemiology , 2020, Definitions.

[36]  Jo Salmon,et al.  Television time and continuous metabolic risk in physically active adults. , 2008, Medicine and science in sports and exercise.

[37]  G. Giles,et al.  Development of the Melbourne FFQ: a food frequency questionnaire for use in an Australian prospective study involving an ethnically diverse cohort. , 1994, Asia Pacific journal of clinical nutrition.

[38]  A. Bauman,et al.  The association between television viewing and overweight among Australian adults participating in varying levels of leisure-time physical activity , 2000, International Journal of Obesity.

[39]  M. Marmot,et al.  Television viewing and other screen-based entertainment in relation to multiple socioeconomic status indicators and area deprivation: the Scottish Health Survey 2003 , 2009, Journal of Epidemiology & Community Health.

[40]  S. Bowman.  Television-Viewing Characteristics of Adults: Correlations to Eating Practices and Overweight and Health Status , 2006, Preventing chronic disease.

[41]  A. Katz.  Letter by Katz regarding article, "television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle study (AusDiab)". , 2010, Circulation.

[42]  H. Kohl,et al.  Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults. , 2005, Obesity research.

[43]  Sanjay Kalra,et al.  OBJECTIVELY MEASURED LIGHT‐INTENSITY PHYSICAL ACTIVITY IS INDEPENDENTLY ASSOCIATED WITH 2‐H PLASMA GLUCOSE , 2008 .

[44]  N. Owen,et al.  Is Television Viewing Time a Marker of a Broader Pattern of Sedentary Behavior? , 2008, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[45]  N. Owen,et al.  Too little exercise and too much sitting: Inactivity physiology and the need for new recommendations on sedentary behavior , 2008, Current cardiovascular risk reports.